Rising Medical Solutions
Rising Medical Solutions is a Chicago-based, privately held provider of medical cost containment, care management, and analytics services for U.S. workers' compensation payers, insurance carriers, TPAs, and self-insured employers, delivered via its proprietary VISION™ platform.
- Company typePrivate
- Founded1999
- HeadquartersChicago, United States
- Headcount251–500
- GTM typeB2B
- OfferingServices
What Rising Medical Solutions does
Rising Medical Solutions is a Chicago-based, privately held medical cost containment and care management company serving the U.S. workers' compensation market, with adjacent capabilities in auto no-fault and disability management. Founded in 1999 and operating with 251–500 employees, the company sells three integrated service pillars — Medical Cost Reduction (medical bill review, hospital bill review, specialty bill review, provider negotiations, and provider networks), Medical Care Optimization (telephonic and field case management, utilization review, peer review, physician pharmacy review, and ancillary care services), and Analytics & Technology (advanced analytics, risk modeling, Rx Intelligence pharmacy analytics) — to insurance carriers, third-party administrators, self-insured employers, and government entities such as Cook County, Illinois.
The technology backbone is the proprietary VISION™ platform, which comprises a VISION Payer Portal, a VISION Digital Marketplace for ancillary care services, and a VISION Patient Portal for Medicare Set Aside administration, all delivered from a HITRUST r2-certified cloud infrastructure. AI-augmented bill review reportedly achieves 99.9% duplicate-bill detection (vs. an 85% industry average) and delivers $8–$78 in client savings per $1 in fees. Rising also operates state-certified provider networks including California MPN, Texas HCN, and the Rising Choice Network™, and licenses Rhode Island and Wisconsin workers' compensation fee schedule databases.
Revenue is generated primarily through transaction-based and professional-services fees invoiced on 30-day terms, supplemented by recurring subscription licensing of fee schedule data and managed mailroom/payment processing services bundled with bill review. The go-to-market is enterprise field sales targeting large payers, supplemented by the VISION platform for mid-market self-service. Notable strategic milestones include the April 2023 acquisition of Preferred Disability Management, the October 2025 hiring of David Dubrof as Chief Growth Officer, 2025 Inc. 5000 recognition, and HITRUST r2 certification in 2024 with recertification in March 2026.
Rising Medical Solutions firmographics
Firmographics- Name
- Rising Medical Solutions
- Legal name
- Rising Medical Solutions
- Website
- https://risingms.com
- Company type
- Private
- Founded year
- 1999
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- Rising Medical Solutions is a Chicago-based, privately held provider of medical cost containment, care management, and analytics services for U.S. workers' compensation payers, insurance carriers, TPAs, and self-insured employers, delivered via its proprietary VISION™ platform.
- Ownership category
- akta.pro rank
Rising Medical Solutions industry classification
Industry- Product category
- Workers' Compensation Medical Cost Containment
- NAICS
- Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)
- SIC
- Services-Health Services (8000), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Care Management & Coordination Platforms (case/disease management workflows) (HLACAHAD)
- akta.pro secondary industries
- Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK), Healthcare Payouts (Payers-to-Providers, Patient Refunds) (FSAMAKAK)
Keywords
Where Rising Medical Solutions is headquartered
LocationHeadquarters
- HQ city
- Chicago
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Rising Medical Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Medical Cost Containment Services: Fee-for-service model for medical bill review, hospital bill review, specialty bill review, provider negotiations, and network services. Pricing is based on standard rates and fees invoiced by Rising, with payment due within 30 days.
- Medical Care Management Services: Clinical services including utilization review, telephonic case management, field case management, peer review, and physician pharmacy review. Charged as professional service fees.
- Data & Fee Schedule Licensing: Access to Rhode Island and Wisconsin workers' compensation fee schedule databases, offered through end-user license agreements.
- Mailroom and Payment Processing: Outsourced mailroom and payment processing services bundled with medical bill review, consolidating bill workflow from intake through payment processing.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Transaction based/ take rate | Pay-as-you-go | Custom service packages based on client needs |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels6 records
Rising Medical Solutions product offering
Product offeringCore offering
Rising Medical Solutions delivers medical cost containment, care management, and analytics services for workers' compensation payers, insurance carriers, self-insured employers, third-party administrators, and auto no-fault insurers. The company's offerings integrate medical bill review, hospital bill auditing, specialty and nurse audit reviews, provider negotiations, utilization and peer review, telephonic and field case management, pharmacy review, and Medicare compliance/settlement solutions. These services are delivered through the proprietary VISION™ cloud platform with AI-powered bill review, advanced analytics, and a digital marketplace for ancillary care coordination.
Product overview
Rising Medical Solutions offers an integrated platform approach combining three core service pillars: Medical Cost Reduction (bill review, hospital review, provider negotiations, and specialty networks), Medical Care Optimization (case management, utilization review, pharmacy review, and ancillary services), and Analytics & Technology (advanced analytics, risk modeling, and pharmacy intelligence). The VISION™ platform serves as the unified technology backbone, offering distinct modules including VISION Payer Portal, VISION Digital Marketplace, and VISION Patient Portal. The company also operates proprietary provider networks (Rising Choice Network™, California MPN, Texas HCN) and maintains state-specific fee schedule databases for Rhode Island and Wisconsin. The offering architecture is platform-plus-modules with the VISION enterprise system enabling all service delivery.
Differentiator
Problem solved
Functional benefit
Brands
- VISION™: Enterprise platform providing payer portal, digital marketplace, and patient portal services for medical claims management.
- Rising Choice Network™
Products and services
- Medical Bill Review
Quantifiable outcome
- $8 to $78 return per $1 in fees for standard bill review; additional $3 to $4 per $1 when enhanced with Specialty Bill Review
- +6 more outcomes
Companies that use Rising Medical Solutions
Customer profileNamed customers1 record
Segments4 records
Ideal customer profiles3 records
Rising Medical Solutions technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature6 records
Rising Medical Solutions partnerships and signals
Strategic signalScale indicators4 records
Recent moves5 records
Expansion highlights5 records
Rising Medical Solutions competitors and assessment
Company assessmentDirect peers
- Genex Services: Provider of managed-care and clinical solutions for workers' comp and disability markets. Overlaps with Rising on case management, utilization review, peer review, and medical cost containment services.
- Sedgwick: Largest independent tech-enabled claims and managed-care provider for workers' compensation. Directly competes with Rising across bill review, case management, utilization review, and integrated payer services.
- Apricus: Workers' compensation specialty services company offering utilization review, peer review, and medical cost containment. Closely overlaps with Rising's clinical and financial service lines.
- myMatrixx: Pharmacy benefit management and pharmacy analytics platform purpose-built for workers' compensation. Directly comparable to Rising's Rx Intelligence offering.
- IMCS Group: Independent medical cost containment and case management provider focused on workers' compensation. Comparable in size and product mix to Rising's bill review and care management services.
- One Call: Specialty network and care management provider serving workers' comp with diagnostics, PT, dental, and transportation services. Comparable to Rising in its ancillary-care marketplace model and payer focus.
- Mitchell International (Enlyte): Provider of P&C claims technology, bill review, and casualty solutions including pharmacy (myMatrixx). Direct competitor in medical bill review and pharmacy analytics.
Broad incumbents
- Optum (UnitedHealth Group): Diversified health services platform with workers' compensation, bill review, and care management capabilities. Competes broadly with Rising across payer services but as part of a much larger portfolio.
- Helmsman Management Services: Liberty Mutual subsidiary providing managed-care services for workers' compensation. Overlaps with Rising on bill review and network services but operates as part of a much larger carrier-owned platform.
- Coventry (CVS Health/Aetna): Workers' comp managed-care services business now operating within CVS Health. Provides bill review, networks, and clinical services at significantly larger scale than Rising.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Rising Medical Solutions social profiles
Digital presenceRising Medical Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
Rising Medical Solutions leadership team
Management profileNumber of profiles
Profiles7 records
Rising Medical Solutions subsidiaries and ownership
Company hierarchySubsidiaries1 record
Rising Medical Solutions funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Rising Medical Solutions M&A and investment
M&A and investmentM&A1 record
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Rising Medical Solutions
What does Rising Medical Solutions do?
Rising Medical Solutions delivers medical cost containment, care management, and analytics services for workers' compensation payers, insurance carriers, self-insured employers, third-party administrators, and auto no-fault insurers. The company's offerings integrate medical bill review, hospital bill auditing, specialty and nurse audit reviews, provider negotiations, utilization and peer review, telephonic and field case management, pharmacy review, and Medicare compliance/settlement solutions. These services are delivered through the proprietary VISION™ cloud platform with AI-powered bill review, advanced analytics, and a digital marketplace for ancillary care coordination.
Is Rising Medical Solutions a public or private company?
Rising Medical Solutions is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Rising Medical Solutions founded?
Rising Medical Solutions was founded in 1999. It employs 251 to 500 people.
Where is Rising Medical Solutions based?
Rising Medical Solutions is headquartered in Chicago, United States, in the North America region.
How does Rising Medical Solutions make money?
Four revenue lines are on record. Medical Cost Containment Services are the primary driver. The others are medical Care Management Services, data & Fee Schedule Licensing and mailroom and Payment Processing.
Who are Rising Medical Solutions's main competitors?
Direct peers on record are Genex Services, Sedgwick, Apricus, myMatrixx, IMCS Group, One Call and Mitchell International (Enlyte). Broad incumbents are Optum (UnitedHealth Group), Helmsman Management Services and Coventry (CVS Health/Aetna).
Does Rising Medical Solutions have an API?
No public API is recorded for Rising Medical Solutions.
What industry is Rising Medical Solutions in?
Rising Medical Solutions's product category is Workers' Compensation Medical Cost Containment. Its primary akta.pro industry code is HLACAHAD, Care Management & Coordination Platforms (case/disease management workflows), with a secondary code of HLACABAK, Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment). Its NAICS code is 518 and its SIC code is 8000.